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HomeMy WebLinkAbout038-1060-20-010 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514947 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Nemeth, Janet I Star Prairie, Town of 038 - 1060 -40 -000 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 15.31.18.261 C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM id Depth BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � Yes [M No FE] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2199 Goose Lake Road New Richmond, WI 54017 (NW 1/4 NE 1/4 15 T31 RI 8W) NA Lot 2 Parcel No: 15.31.18.2610 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? O Yes FU No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) comffmme_wi.gov Safety and Buildings Division County 201 W Washington Ave., P.O. Box 7162 sco nsin Madiso 53707-7162 Sanitary Permit Number (to be filled in by Co.) Qepartment of Commerce 5 ly 1 7 4 1 77 Sanitary Permit Applie t i StateTrsnsactionNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form o oriate governmental AIW unit is required prior to obtaining a sanitary permit Note: Application forms for ab WTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal inf rbc used or secondary purpo in accordance with the Privacy Law s. 15. 1 m tats I. Application Informa$ - Please In ation / f ` FRRK.. Property ner's Name Parcel # AUG 0 5 2000 035 - 113(00 Property Owner's Mailing Address ST. CROIX COU Property Location f� NTY ^� b fl G NING OFFICE GovL Lot C ' L City, State Zip C one Number,, Section /S le ; R cur one IL Type of Building (check aB that apply) ©r L # T L N; R E o, V 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name <j yw' Block # El 1 Public/Commercial - Describe Use - _ � V ❑ City of ❑ CSM Number El Village 0f Owned - Describe Use �J 1 , t V a (•�vld.sv / JO Town of Z c✓ 1 ,f- IIL Type of Permit: (Check only ont box an sine A. Complete line B if ap A. J New System ❑ Replacement 3 cp ystcm 0 TreatrncretlHoldurg Tank Replacement Only ❑ Olbcr Modification to Existing System (c+rplam) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Tramfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POMrrS Sys tem/Com ent/Device: Check aD that a g Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound >_ 24 in. oaf suitable soil ❑ Mond < 24 m. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. DispersalfIrreatnient Area Information: Design Flow (gpd) esign Soil Application Ra gpdst) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation t / ✓/ ✓/ — & A7r -' Vr Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks v U m Al i ei6 — U rn m rn 4.0 p, Septic or Holding Tank Dosing Climber VIL Reslignsibility Statement- I, the undersigned, assume responfibility for installation of the POWTS shown on the attached plans. Plum r' ame t plumber' ipmoirc MPIl\MS Number Business Phone Number Plu ber's 4ddress (Street, City, State, Zip ) -E ,rn 1 zfL T - VIIL Coun /De artment Use Only roved ❑ D' it Fee Date Issuing t Signature � ❑ err en for Denial IX. Conditi amim for Disapproval /� • J� c t. Septic tank, eftlutnt lifter and 3 ) C DA�" n wI T dispersal cell must all be services / malntttined / b �t y - � ` � � �•� LJda> as per management plan provided by plumber. (- J .�-� r t 2. All setback r"Wrements must be hed 3r k pMQ o ,n. 1 ° ✓., r b Abu - AJ Attach to complete plans for the > sad submit to the Coa � � y ks jhaa t: t� i 11 ; f; awe SBD -6398 (R. 01/07) Valid thm 01109 4, 6 ,,J h, Q, � Ptao : %Jcj41s � A-) s/ Q 01' ` 312 e%ys fir/ I X 1 '\ oust lecopy //liJ // . All X SCE A ' l �/� ,Aj K o � 1 r \� j , �b A� "•� �\ _. -`cam Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ?Q y / -TU percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0317 / l �C.LAJ Please print all i Revi by Date Personal informabon you provide may be used for a 75. m)). Property er Property Location Govt. Lo 1/4 114 S T N R E (or Property Owner's Mailing Address AUG Lot # Blo # I Subd. Name or CSM# C City S Zip a S7Pl�p FFICE ❑City [I Village ®Town Nearest Road New Construction Use: Residential J Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ �; gsh/ Flood Plain elevation if applicable ft. General comments (� Go,nicpJT and recommendations: S .s�� .- 3 Boring # F] Boring jo Pit Ground surface elev. "a ft. Depth to limiting factor y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Copt. Color Gr. Sz. Sh. *Efi#1 *C-ff#2 - i ti n Boring # Boring l x r ® pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 q 9 t f * Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 _ 150 mg/L fflu nt #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (PI rrt) Signature CST Number l' 3 Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # Page x Of 5 Boring # ❑ Boring Pit Ground surface elev. �_ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz nt. Color Gr. Sz. Sh. *Eff#1 *0102 i a 4 G Q F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mgA- " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.07/00) I I Property Owner Parcel ID # Page of Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF in. Munsell Qu. Sz Pont. Color Gr.,�z. Sh. *Eff#1 *Eff#2 t 1 J 3 A5 3 _ a 4 Q F -1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 F-1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure ;Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 220 mglL and TSS >30 : 5 150 mgA. Y, Effluent #2 = BOD < 30 mglL and TSS < 30 mgA- The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. 8BD- 8330OL07/00) A3�� 3 ��.�� /I/,Ei�,�' >� �✓J�/ i(/� - � ��/ sic i� >��� ���L� oA'A f 9 1 3L �. c 435740 CERTIFIED SURVEY MAP Located in the NW 1/4 of the NEl) /,4 of Section 15, T31N,R 18W , Town of Star Prairie, St. Croix County, Wisconsin. Surveyed for: Sandor Nemeth Rt. 2 New Richmond Wi. N 1/4 COR. _ SECTION 15 ( I" IRON PIPE I FOUND ) m �V J cD I O Np I O N POINT OF fr N68 0 1055 "W 30.45' BEGINNING 160.59' N89020'56'W �= O I I� W J O F, O I W W W W 3 � LOT 3 W I W R of 31n ?� a� (1 87277 S. F. tD 1 1� I J I �. 2.004 AC. ` • In d' to 1 �' ¢ OI C ° I • / W H W I I t 0 : off q W z � O =) I �Wa W u I y N CENTERLINE OF � F EXISTING GAS LINE = a -so > 189.00' m c Z S89 '55"E I \ LEGEND o I "X 24" ROUND IRON PIPE WEIG HING I.16LBS /LIN FT. ` ('Q �r1�I I I SET OVE y�� I • t "ROUND IRON PIPE FOUND '• I � �t 2. SCALE IN FE ET 1" a ISO' �; o I5 300' W.p IV U SU �_Z I I tr�1 __� _Vol._ .7_ Pav_e 1950 �'!� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address s Property Address ...,... (Verification required from Pl & Zoning Department for new construction.} ' v City /State „E J--, Parcel Identification Number LEGAL DESCRIPTION Property Location 1 14 , =' /a ,Sec. , T 1V R_�W, Town of S�Sac �,rC, A" ;�� Lot # Z " T Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes //t►o/ Lot lines identifiable 1 no v SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein. as set by '";e Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Deoaru « 30 days of the three year expiration date. I / certify that all statements on this form are true to the best of my /our knowledge. Uwe amiare the owner(s) of the property described above, by Virtue of a warranty deed recorded in Register of Deeds Office. Nu er of bedrooms SIGNATURE OF APPLICANT(S) DATE ** * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department :- : i ade «-ith this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -ease is made in the warranty deed. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _/ of FILE INFORM TiON SYSTEM SPECIFICATIONS Owner y Septic Tank Capacity a l ❑ NA Permit N Septic Tank Manufacturer 1 S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer t ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units C: NA Pump Tank Capacity ga l Nf'NA Estimated flow (average) gal /day Pump Tank Manufacturer CI-NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ;21-NA Soil Application Rate gal /da /ft2 Pump Model P`NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit , YNA Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD < 220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: j Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (ROD < 30 mg /L _P1 in-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L 5dNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA -0 year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (% of tank volume ❑ NA (aspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA I9 year(s) y Clean effluent filter At least once every: ❑ month(s) ❑ NA years) 'rj)anect pump, pump controls & alarm At least once every: ❑ month(s) UNA ❑ year(s) Flush fate-als and pressure test At least once every: ❑ month(s) J2kNA ❑ year(s) czher: At least once every: ❑ month(s) ❑ year(s) ❑ NA Otfie,r.' ❑ NA VIAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (% or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page -,::22- of o7 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore. normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to i e 9 P insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. �7 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE POWTS MAINTAINER Name Name Phone _ L Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s Phone Phone This document was draLeJ '- _-c` ante with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page --C2 of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material, CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. �T A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 7 Phone Phone This document was draLet c ~ance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r OD Nog �` t i� STATE aAR OF vL%co; Fo+4u,2 V -v 5PACE REST - -ED 'OR F4r_0% &ftG f.) ATAa > K -- BX 4FIIS QEFQ, d9' in�7ie._f2t�nni.i� c�_.53..Zg t�atYa�n - - -- REGISTERS.Qf�:CE E;:•aol con.•eys xnd . to .� N e — )I! , Ott _ and .ian e.,f eme th ; - tLUE - :�r� ;? f� as ioint t en�h i s . - .. - - -- of — r .1 — - - - - -' — -- -- —= -- -- r 7.c� -- - - - - - -- ",' Sayalsr of fur a vat t,ab)e .:oasi.deratior_ One 5 1.00 -p_ ? .Jar , an d,- . RETUAN TO ab Cons __r — __.___ __ the foliowing described real Estate is St- Cr01 Court y, Stutz of Te i.seo - .CI,MiSFER Tax K&y r - 1 t w � Lot 2 of Certified Survey flap, recorded in This is b"Mestend graprr:y. 2, page 315, as Docu_merit 6336170 in the office. of the Register of Deeds,St. Croix County, Hudson, Wisconsin. - Also, Right- of - Way Easement for ingress and egress over - t - y located in the Northwest Quarter of the Northeast Quarter (1� W of <) of Section Fifteen (15) To.rr_ship Thirty - one ( :31) Lord;, Ran g7a- E.LaIntteep (18) West, Tonrl? of Star Prairie, St. Croix County, Wisconsin, being .further described as follows: ii `� Commencing at the North >< corner of Section . 15 ; thence _So?jth 04 3 r 4,E° West along the Quarter- Section line a distance of 228.24 feet to the f i; nni nt- of heninnina- _ - E - thence South 68` 10'55" East_ 43.59 i.. et; thence South 492 :�ti °4 feet; thence- .._Sout3 ,O_~ §314.6'-- tFeSt- 66 :6ff-�ge�c t�?ence��rnt�- y��_C�. �. _ West 504.68 feet; thence Nord 63 west 30.45 feet, thence -North 0 East 70.74 feet to the point of beginning.- _ Above Lot and Right -of -Way are located in the- Northwest Quarter of f Northeast Quarter of Section 1S, Township 31 - Nort.h,Rangc la West. �9 Exception so warranties: l W s nsin Noveib 1s�76 _ t Executed at AIeW F21 CO tbls do o[ , t it j StC;NF,D AN[) SEALED IN PRESENCE OF I_. e r i n ter J i i� 1 3s _ t - Y i a ores 5 i t n1.e --2 g i { auffieutiaeted this day of_ 'i Herdrik W. Vary D k Title: Mrtuber State Bar of Wisct aEin or Other Party t� �i Authorized under Sec - Ob.Ob eta. _ S')'A L: OF WISCONSIN ) j - - ----' e this — _ 19 before m _� Personalty came the above to me known to be the person_, who executed the foregoing instrument and eckeowledged the some_ it Thi; instrument was rrrafted by krINSTRA & VAN DYK At,h.1 Notary Public_ _ County, Wis. 1� New Richmond,WI 54017 The use of witnesses is cptional. My Commission (Expiues) Us) i! Names or persons signing in any capacity should be typed or printed below the s.gnatures. 1 xe teateteo..ma� T -c✓ —S T AT. F EAR OF - CONG.. TOWN OF S rA ' R PRA IRIE N 1/4 COR. SEC. 15 533.11 ` N N LOT 1 4 v 261 B " ! \ \� 49 2.44 M 410.95 W� cr- NW 114 3 (V N w v W� 2 N J I 261 C 261 A m a ►4q OD �1 cc �v 0) >i f f cc �1 to C) Ld P, c� W� Vi -- — 43 9.4.3' 4ir p' I I I b qD